Toenail Fungus & Treatments
Nail fungus is a common medical condition that can affect the nails of the hands or the nails of the feet. The medical term that describes a fungal infection of the nail is onychomycosis. This page provides information about what causes nail fungus as well as some of the treatments for nail fungus. Although most people just want the nail to look better, the appearance of the nail is the least important reason to treat this infection.
The image above is just an example of a toenail that has been infected by a fungus. Because the infection can be caused by different types of fungi, not all infections will appear the same. Some nails may appear much thicker while others may just have a slightly yellow color. The nails of some patients turn darker or almost black. Keep in mind, it's better to have a licensed doctor with experience treating nail fungus to examine your particular issue.
Causes of Toenail Fungus
Fungi will not infect healthy nails in people who are perfectly healthy as a general rule. However, there are some exceptions. People who have been determined by a doctor to have no medical issues should focus more on prevention after treatment is complete.
People who have medical conditions that make them more susceptible to developing a nail infection should be sure that the underlying cause is being treated.
Types of Fungi that Infect the Nails
There are 3 types of fungi that are responsible for the vast majority of nail fungus infections:
Between the 3 types of fungi listed above, an overwhelming majority of cases are caused by dermatophytes.
Risk Factors for Developing Nail Fungus
Some of the risk factors for developing nail fungus include:
Peripheral neuropathy, including diabetic neuropathy
Type 2 diabetes
Autoimmune disease ( rheumatoid arthritis, lupus, etc.)
Peripheral artery disease or venous insufficiency (poor circulation)
How is Toenail Fungus Diagnosed?
An infection of the toenail by a fungus is usually diagnosed by a visual examination of the nail along with your medical history and predisposing risk factors. In rare instances or in cases where there have been multiple failed treatments, a doctor may take a sample of the nail to have the laboratory analyze it.
Treatments for Toenail Fungus
There are many different ways to treat toenail fungus. Generally speaking, toenail fungus is very difficult to treat and may require many attempts to treat the infection using several different kinds of methods. The simplest way to treat nail fungus is by using over-the-counter treatments. However, OTC treatments, although initially appealing and convenient, have an extremely high failure rate.
Fungal infections of the toenail are somewhat opportunistic. This means that it is extremely rare for perfectly healthy people to develop this types of infections. As a result, any treatment should be done in addition to treating the underlying issue. Schedule an appointment and we'll show you how.
Topical Treatments for Nail Fungus
Topical treatments for fungal nail infections typically come in the form of a clear nail polish, cream, or both.
There are four topical treatments for nail fungus that have been approved by the FDA. These medications include:
It is worth noting that although the FDA has approved the above medications for the treatment of nail fungus, the failure rate is high. The way these medications work is by preventing the spread of the fungus to the new portion of the nail as the nail grows. As a result, many patients are forced to use the medication for as long as 12 to 18 months, which is the length of time it takes for the new nail growth to replace the old nail.
Pills to Treat Nail Fungus
There are a few oral medications (pills) that can be used to treat toenail infections caused by a fungus. However, these medications can be a hassle. First, fungi are relatively complex when compared to virus and bacteria. As a result, the medications used to kill fungi can also damage human cells.
The pills used to treat toenail fungus have the ability to damage the liver. As a result, many physicians will want to do blood work so that they can check your liver function (LFTs). Depending on the dosing regimen chosen by your doctor, you may have to have blood taken multiple times to check your liver function.
Some of the pills you may be prescribed for nail fungus include:
Depending on your doctor and the specific situation, your doctor may choose to use both a topical medication and an oral medication.
Alternative Treatments for Nail Fungus
Alternative treatments have become more popular over the years. This popularity is likely because of the difficulty involved in treating toenail fungus. Some alternative treatments are just old home remedies without any scientific basis. However, there is frequently some scientific reason why people think it should work, even if it doesn't.
Laser Treatment for Toenail Fungus
Laser therapy, including cold lasers or low-level lasers, have sparked interest in the field of treating toenail fungus. Although the FDA has cleared laser devices for the treatment of toenail fungus, the clinical results over time have not been all that was hope for. For example, a study in 2022 comparing the use of urea versus a fractional laser revealed that pretreatment with urea has greater long-term effectiveness in curing nail fungus.
As for the reasons that cold laser therapy hasn't been more popular - it likely comes down to the cost of treatment. Treatment costs for laser therapy range from $700 to $1500. When compared to the cost of prescription medications, cold laser treatments tend to be far more expensive treatments for nail fungus.
Home Remedies to Treat Toenail Fungus
There has not been any extensive medical research on the use of home remedies to treat toenail fungus. A few remedies that are alleged to help include:
Tea tree oil
Vinegar (including white vinegar)
Black Tie Health™ cautions against the use of these remedies as the results could be harmful or unpredictable.
Homeopathic Treatments for Toenail Fungus
Homeopathic treatments typically differ from the mainstream medical consensus. While being homeopathic in and of itself does not mean the product is ineffective, there is rarely any scientific evidence that these products work.
Zetaclear - ~$109. There is an oral spray and a polish available. The oral spray supposedly contains antimonium crudum, arsenicum album, mancinella, nitricum acidum, sulphur, and thuja occidentalis. The nail polish contains undecylenic acid, tea tree oil, clove oil, almond oil, jojoba oil, lemongrass oil, lavender oil, and vitamin E.
Nail-Rx - Contains water, formaldehyde, ethanol, potassium hydroxide (lye).
Fung-b-gone - ~$15. Supposedly contains black walnut, grape seed oil, chamomile and bees wax.
As with the home remedies above, Black Tie Health™ cautions against the use of homeopathic remedies as the results could be harmful or unpredictable. In addition, unlike the home remedies above, the costs of some of these products can be much higher. Also, some of the product, like Nail-Rx, contain substances that should not be routinely put on the skin or nails -formaldehyde.
When All Other Nail Fungus Treatments Fail
If you've tried all of the above treatments, you may want to consider just cutting it off. Not the toe - just the nail. There's a procedure that can be performed by your doctor to remove the entire nail. This can be done using chemical or removing the nail surgically. Surgical removal of the nail is a procedure typically done in the office with a local anesthetic (numbing agent).
Ultimately, we recommend first scheduling an appointment with a licensed physician that has experience in treating toenail fungus.
DO YOU LIKE WASTING TIME AND MONEY ON NAIL TREATMENTS THAT DON'T WORK?
Gupta AK, Jain HC, Lynde CW, Macdonald P, Cooper EA, Summerbell RC. Prevalence and epidemiology of onychomycosis in patients visiting physicians' offices: a multicenter canadian survey of 15,000 patients. J Am Acad Dermatol. 2000 Aug;43(2 Pt 1):244-8. doi: 10.1067/mjd.2000.104794. PMID: 10906646.
Alberdi E, Gómez C. Urea versus fractional Er:YAG laser pretreatment of methylene blue photodynamic therapy in the treatment of moderate toenail onychomycosis: short- and medium-term effects. Arch Dermatol Res. 2022 Oct 31. doi: 10.1007/s00403-022-02448-7. Epub ahead of print. PMID: 36316511.
Falotico JM, Lipner SR. Updated Perspectives on the Diagnosis and Management of Onychomycosis. Clin Cosmet Investig Dermatol. 2022 Sep 15;15:1933-1957. doi: 10.2147/CCID.S362635. PMID: 36133401; PMCID: PMC9484770.